* THE BIGGEST ISSUE FOR CARDVIOVASCULAR OCT IS THE LACK OF STUDIES TO DATE WHOSE DESIGN WOULD LEAD TO A CHANGE IN PATIENT MANAGEMENT*

Optical coherence tomography (OCT) is a micron scale imaging technology based on infrared light, which allows micron scale imaging. This site seeks to move the technology forward quicker to produce clinical data that will lead to improved patient morbidity and mortality.

Originally a slow table top technology for imaging transparent samples such as fiber optics and retina, for the last 18 years OCT has been developed for intracoronary imaging, particularly identifying high risk plaque and guiding coronary interventions. This was unusual in that the first applications pursed in nontransparent tissue was intracoronary, rather than less invasive pathologies (1993). This was initiated by Dr. Brezinski, a basic scientist and cardiologist at MGH and Havard (in collaboration with James Fujimoto PhD and Eric Swanson M.S., among others). Neil Weismann MD and the late ‘Chip’ Gold MD, both cardiologists at MGH, made early contribution. About the time of the new millennium, I.K. Jang MD would also become involved with the technology.

In its first five years of investigation (through the 90’s), it had been rapidly transformed into a catheter based, high speed, portable technology capable of in vivo imaging. In addition, its superior resolution to IVUS was demonstrated, adjuvant techniques such as those that measured tissue collagen or tensile properties were developed, and a feasibility for identifying high risk plaque and assessing stent placement were demonstrated. With this rapid start and the advantages of the technology, why has a role for it in clinical practice yet to be established? This was the motivation for this web site, to move the technology forward to patient management at a rate faster than the previous decade.

In part, OCTs relatively slow progress between about 2000-2010 may relate to the fact that in the early part of the decade, the technology was only available to a limited number of investigators and much imaging effort had protocols with inherent designs that would not yield true clinical outcome information. This included both clinical studies being generally focused on single time point images which did not take advantage of OCT adjuvant techniques and some technological advances improving data acquiring capacity; both not necessarily increasing clarification of clinical utility. As the technology has become more generally available to skilled clinical and basic scientists in recent years, it has been a useful tool for studying late acute occlusion with drug eluding stents (DES) and investigating potential markers of DES success. But in terms of identifying plaques that lead to ACS, progress has been minimal most notably because of the insufficient amount of work on plaque markers. This site reviews the development of cardiovascular OCT, current understanding of coronary pathophysiology, and the potential approaches that can be taken to achieve general acceptance of OCT for patient management.

Cardiovascular OCT. These images came from the first OCT paper imaging coronary plaque (and non-transparent tissue in general). The top is a lipid filled plaque where the arrow shows an area of intima less than 40 µm in diameter. The dark area is lipid. In the bottom image, a fracture in plaque is shown by the red arrows. The bar represents 500 µm. Courtesy Brezinski, M.E., et.al., Circ., 1996. 93:1206-1213.